Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute

ABSTRACT: Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure, and the surgeon should be prepared to address bone tunnel osteolysis, concurrent meniscal, ligamentous, or cartilage lesions, and limb malalignment. ACL revision can typically be done in one procedure, but it may need to be staged if there is poor previous tunnel positioning or excessive tunnel osteolysis. Bone grafting of the tunnels can be accomplished in several ways, including autograft, allograft, or bone substitutes. Currently, no consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision ACL reconstruction. Bone graft substitute for tunnel augmentation has been showed to have good histologic, radiographic, and intraoperative integration, comparable to that of autologous bone. In this Technical Note, the technical details of arthroscopic treatment of attenuated anterior cruciate ligament graft with enlarged bone tunnels are described. The tunnels are debrided arthroscopically and filled up with PRO-DENSE injectable regenerative graft. Technique Video Video 1 Arthroscopic treatment of attenuated anterior cruciate ligament graft with enlarged bone tunnels of the right knee. The patient is in the supine position. The anterolateral portal is the viewing portal, and the anteromedial portal is the working portal. The lax anterior cruciate ligament (ACL) is resected. The femoral bone tunnel is debrided, and the tunnel wall is microfractured. The tibial bone tunnel is debrided with the ACL reamer, while the articular opening is covered with an arthroscopic curette. The tibial bone tunnel is further debrided with an arthroscopic shaver and burr via the tunnel. The fluid irrigation is switched off and the subsequent steps are performed under dry arthroscopy. The femoral and tibial bone tunnels are filled up with injectable regenerative graft.

SUBMITTER: Mak C 

PROVIDER: S-EPMC9243602 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature